Coaching program builds resilient residents

Where: Massachusetts General Hospital, a 1,011-bed teaching hospital of Harvard Medical School
in Boston.

The issue: Improving the well-being of internal medicine residents.

Background

As chief resident of Mass General's internal medicine residency program, Kerri Palamara,
MD, FACP, saw a need for residents to receive emotional support from more experienced
clinicians who have little impact on their careers. So in 2012, she started the Professional
Development Coaching Program, which matches trainees with volunteer coaches outside
of their discipline to help them navigate the highs and lows of residency. A trainee
interested in pursuing cardiology, for example, might be matched with a gastroenterologist.
“That creates this opportunity for a safe space for the resident to have a
conversation . . . about a number of insecurities that everybody has as they're going
through training,” said residency program director Jatin M. Vyas, MD, PhD,
FACP.

How it works

While this may sound like a simple buddy system, “what [Dr. Palamara] added
to that was to provide the faculty members training on being a coach,” he said.
The volunteer coaches, many of whom are teaching faculty, receive training in positive
psychology and coaching principles.

The program is strongly encouraged, but it isn't mandatory (with 199 trainees, there
are always a few who aren't interested), said Dr. Vyas, also an associate professor
of medicine at Harvard Medical School. When residents join the program, each one is
assigned a coach and expected to check in a minimum of three times a year, he said.
At each meeting, the coaches help trainees reflect on their experiences, set goals,
and engage in dialogue that encourages positive emotions and strengths.

Results

After the first year of the program was linked to a reduction in interns' emotional
exhaustion, Dr. Palamara and colleagues decided to study its impact more formally
over three years. Each year, the pairs were encouraged to focus their initial meeting
on specific ways to encourage professional and personal success. In the first year,
they worked on exploring strengths, building resilience, and finding meaning in work.
The second year fostered leadership development and emotional intelligence, and the
third year focused on leading authentically, finding passion and purpose, and cultivating
life's lessons.

Of 179 residents who were assigned a coach in the 2014-2015 academic year, 56% fully
participated in the program, and 73.1% of them reported good or excellent experiences
with their coaches. Participation in the program was significantly associated with opportunities for reflection, a positive residency experience, and increased coping and relationship skills, according
to results published online in July by the Journal of General Internal Medicine. Dr. Vyas views the program as complementary to traditional mentorship, which “focuses
more on the career; the coaching program focuses more on the person.”

Challenges

The biggest challenge was normalizing discussions about personal challenges, as many
trainees hide their insecurities to guard against perceptions of weakness, Dr. Vyas
said. “Part of the difficulty is really to try to get residents, and interns
especially, to recognize that this is part of growing as a physician,” he said.
Other challenges included the administrative burden of tracking participation in a
large residency program and the amount of time spent training the coaches.

A final barrier is that the faculty members are already very busy and aren't specifically
compensated for participation, Dr. Vyas noted. “But we see this as necessary
to creating the right learning environment and promoting this kind of positive psychology
for the next generation of physicians,” he said. Retention of coaches has been
high, and the program currently has more coaches than coaching positions, Dr. Vyas
reported.

Next steps

In the future, Dr. Palamara hopes to analyze the program's impact on residents who
have graduated, according to Dr. Vyas. She has also helped other residency programs
start their own professional development initiatives, he said. “It's actually
moved beyond internal medicine to many other disciplines of medicine,” such
as Mass General's anesthesiology residency program.

Words of wisdom

The newest generation of physicians faces an intense work environment, Dr. Vyas noted.
“There are certain elements of patient care in the 21st century that require
a resilient physician, and we need to ensure that training programs are in a position
to permit that type of growth,” he said. “In my mind, this is a program
that is a great tool in our arsenal to combat burnout.”

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.